Category Archives: Health Care

Virginia Health Rank Improves to 15th Best

Source: America’s Health Rankings

by James A. Bacon

Virginia has improved from 20th place last year to 15th place this year among the 50 states in America’s Health Rankings compiled by the United Health Foundation. The report cited the Commonwealth as one of three states that “made the largest improvements in the rankings since 2018.” (See the Virginia health profile here.)

Virginia strengths: a low crime rate, a low percentage of children in poverty, and high immunization coverage among children. Since 2012, smoking has decreased from 20.9% of adults to 14.9%. Air pollution has decreased, and so has infant mortality.

Virginia challenges: a low rate of mental health providers, low per capita public health funding, low meningococcal immunization among adolescents. Drug deaths are up, frequent mental distress has increased, and so has the rate of chlamydia.

Overall, the story is a positive one. To what does the Commonwealth owe this improvement? Continue reading

In Failure, the GOP Has an Opportunity to Reinvent Itself

Todd Gilbert, House Majority Leader and soon-to-be House Minority Leader: GOP must learn to appeal to suburban voters.

by James A. Bacon

So, the Republicans have wrapped up their annual “Advance” — a retreat at the Omni Homestead resort in Bath County. And if reports of the two newspapers that covered the event are to be believed — one from the Washington Post and one from the Roanoke Times — GOP leaders have absolutely no clue how to become competitive statewide.

Attendees do agree that they got shellacked in the November election, and they share a vague sense that they need to increase their appeal in the suburbs. But their only hope at this point resides in the conviction that Democrats will over-reach with Trump Derangement Syndrome in Washington and enact California-style legislation in Richmond. If voters get buyer’s remorse, they might start voting for Republicans again.

But you can’t defeat something with nothing, and there is no indication in either news account that Republicans gave much thought to what they stood for, other than not being insane. Continue reading

Two Medicaid Updates: Work Requirement, PBMs

By Steve Haner

Medicaid Work – Training Requirement Dead

Disappointing many, thrilling many, and surprising nobody, the Governor of Virginia has openly broken his 2018 promise to couple expanded Medicaid coverage with a work or job training requirement for able-bodied recipients. Moving people out of poverty is no longer the goal.

Governor Ralph Northam was quoted in posted story by the Richmond Times-Dispatch saying:

“Virginians made clear they want more access to health care, not less. Given the changed makeup of the General Assembly and based on conversations with new leadership, it is unlikely Virginia will move forward with funding a program that could cause tens of thousands of Virginians to lose health care coverage.”

To which outgoing Speaker Kirk Cox responded:

“The Governor and I made personal commitments to each other on this long-term public policy agreement. There wasn’t an asterisk that said, “unless my party wins the next election.” It’s a sad reflection on the value of integrity in modern politics.”

Continue reading

Rent Seeking, Runaway Medical Costs, and the Middle-Class Squeeze

Source: The Commonwealth Fund

by James A. Bacon

Mirroring national trends, Virginia healthcare markets are severely out of whack. The main difference is that here in the Old Dominion, they’re even more out of whack than they are for the country as a whole. In 2018, total out-of-pocket medical insurance costs for Virginia employees (employee contribution to premiums + deductible) amounted to $8,143 — 10.2% more than the national average.

That’s on top of what employers pay. According to the latest data compiled by the Commonwealth Fund, employers on average contribute $6,635 for single coverage and $19, 512 for family coverage. Add up the employer and employee share, and the cost of family coverage is equivalent to about $13.30 per hour in earnings for a full-time employee.

These costs have rapidly outpaced the general cost of living. As a percentage of median income, out-of-pocket costs have increased from 6.9% of median income to 10.7%.

Out-of-control medical insurance costs constitute a crisis for Virginia’s middle class. While the public policy debate in Richmond has focused almost exclusively on how to extend insurance coverage to the poor and working poor in the form of Medicaid expansion and Obamacare, nothing more than lip service has been given to the crisis for people who pay their own way. Continue reading

The Issue of Guardianship and the Contribution of a Newspaper

Ora Lomax with a picture of her husband, William, who was committed to a nursing home against her wishes. Photo credit: Richmond Times Dispatch

On Sunday, the Richmond Times-Dispatch ran a remarkable article. It was remarkable both in the amount of space the newspaper dedicated to it, 5½ whole pages, and its subject, guardianship, a subject about which little is known by the public, but that could affect anyone.

The publishing of this series of articles illustrates the continuing value of newspapers. The RTD invested a lot of resources into this story. It was a year-long investigation in which staff combed through the records of hundreds of guardianship cases originating in the Richmond circuit courts. They examined all the public documents related to those cases. They created a database with all the relevant data from those cases. They also looked at some guardianship cases filed in Henrico and Norfolk circuit courts to see how such cases were handled in different jurisdictions. They interviewed dozens of people and attended guardianship hearings. No other media for the general public could, or would, dedicate this amount of resources to a single topic. Continue reading

The Bureaucratic Nightmare of Hospital Billing

by James A. Bacon

It’s not easy going through life with Parkinson’s Disease, afflicted by tremors, stiffness, fumbling hands, and difficulty walking. Carrying on becomes a real challenge when you add debilitating rounds of chemotherapy. That’s the predicament my old friend Lisbeth finds herself in these days: fighting off two terrible diseases at once.

As you can imagine, the last thing Lisbeth needs as she’s trying to keep it all together is to get into a billing quarrel with her hospital. Most people in her condition would be too exhausted to study their hospital bills and spot the errors, much less to contend with an unresponsive hospital bureaucracy to get her money back. Most people would just let it slide. But Lisbeth isn’t like most people. She’s a crusader at heart, and her maladies have not conquered her spirit.

Lisbeth knows I blog about health care from time to time, and she approached me to tell her story. She laid copies of bills, correspondence and her  contemporaneous notes before me and walked me through her healthcare hell. Compared to tales of medical malpractice like amputating the wrong foot or contracting fatal infections in the hospital, this was tame stuff. What struck me, however, was that her complaints, though banal, are likely endemic in the healthcare system. Continue reading

Inmates Need Costly Medical Care, Too

by Dick Hall-Sizemore

In the most recently completed fiscal year, the general fund cost to provide medical care to Virginia prison inmates was $221.6 million.

That is a lot of money by any measure; it exceeds the entire budget of all but a few state agencies. However, despite its size, it does not get much public attention.

Like the state budget, medical costs threaten to consume the DOC budget.  The FY 2019 expenditures constituted more than 18% of the agency’s general fund budget. Each year, the budget request for additional funding for medical services is at the top of DOC’s list. Its FY 2019 appropriation for medical services exceeded its FY 2017 appropriation by $34.8 million. For the upcoming biennium, the agency has requested an additional $21.8 million in the first year and $28.3 million in the second year. Continue reading

Republicans Must Find a New Way Forward

by James A. Bacon

Virginia is a blue state now. Not only do Democrats occupy all statewide elected positions — two U.S. senators, governor, lieutenant governor, and attorney general — with yesterday’s election, they control both houses of the General Assembly.

Republicans got their booties  kicked. And the butt-stomping is not likely to subside. The Dems will control the next redistricting, which will cement their dominance of the legislature. Auguring well for the blue team in the future, the fastest-growing region of the state, Northern Virginia, now is pure blue with bits  of purple on the exurban fringe. By contrast, Republican strongholds in rural Virginia have shrinking or stagnant populations. Also favoring Democrats in the long run is the increasing percentage of racial/ethnic minorities in the state and the declining percentage of whites.

Republicans need to re-define who they are and what they stand for, or they will become a permanent minority. News reports say that dislike of Donald Trump drove Democratic voter turnout, but the Blue Tide is much broader and deeper than voter animus of one man. Take Trump out of the equation after the 2020 election, and Virginia Republicans still have a huge problem.

Can the Republicans re-calibrate? I certainly hope so, because I’m terrified of the Democratic Party agenda of $15 minimum wage, spiking the right-to-work law, a damn-the-torpedoes-full-speed-ahead rush to a 100% renewable electric grid, spending and taxing, taxing and spending, and injecting its grievance-and-victimhood agenda into the consideration of every issue. But Republican priorities on culture war issues — guns, abortion, transgenders — are not winning issues statewide. As long as Republicans remain captive to its rural/small-town base, I don’t see how it can reinvent itself.

What does a rejuvenated Republican Party look like? (Or, if the GOP is incapable of reinventing itself, what does a successor party look like?) Continue reading

The Radioactive Donors In 2019? Healthcare

Money (And Hypocrisy) In Politics

By Steve Haner

The following is one of my “revise and extend” follow-up posts, this one adding detail to an exploration of the raging attacks on Republican efforts to offer alternative health insurance plans.  You can read the original post on the Jefferson Policy Journal.    

Not many months ago, it was a safe bet that by late October the campaign attack ads would focus on utility contributions. There is still time for that to appear. Dominion Energy clearly expected that, as evidenced by a full page, very defensive advertisement in Wednesday’s Richmond Times-Dispatch. Then there is its most cloying television ad yet.

You’ve seen it, of course – the lovely young lady whose Daddy is a deployed Dominion employee. Instead of wearing a U.S. Army or Blue Star cap, she sleeps and poses for school pictures in his Dominion Energy hat. Now, how could a company engendering that kind of love and loyalty be misbehaving?

Continue reading

Hey, Governor, How About the Rest of Us?

by James A. Bacon

Having expanded Medicaid coverage for more than 325,000 Virginians, Governor Ralph Northam now has issued an executive order directing actions to increase the number of Virginians enrolled in “quality, affordable health care coverage.” Secretary of Health and Human Resources Daniel Carey will explore ways to expand Medicaid enrollment, reduce insurance premiums, increase transparency of insurance choices, and develop a “data-driven strategy to create efficiencies in coverage and improve outcomes” with a special focus on “vulnerable” populations.

We won’t know what these initiatives will cost the non-vulnerable (the vast majority of Virginians) until we see the proposals. But as Carey undertakes his inquiries, he and the Governor would be well advised to remember how much health care in the form of Medicaid is already costing the state.

State General Fund spending on Medicaid services has increased from $2.29 billion in Fiscal 2010 to $4.88 billion in Fiscal 2019, according to a recent update on state spending by the Joint Legislative Audit and Review Commission. That was an annual growth rate of 9% yearly, and it accounted for 39% of the growth of all General Fund spending, crowding out other priorities.

Meanwhile, the Kaiser Family Foundation has found that the average cost of employer-provided family health care coverage now exceeds $20,000 a year, with workers paying slightly more than $6,000. That’s a 5% increase from last year — and it doesn’t take into account steadily rising deductibles and co-pays. Middle-class Virginia households are caught in a triple whammy — supporting ever-inflating Medicaid costs, paying more for their own insurance, and paying more out-of-pocket. Continue reading

So Much Health Care Data, So Little Actionable Information

Palliative care grades by state. Source: released 2019 “State-by-State Report Card on Access to Palliative Care in our Nation’s Hospitals”

by James A. Bacon

There are many ways to gauge the quality and cost-effectiveness of Virginia’s hospitals. One is to measure cost and efficiency. Another is to track mortality rates and re-admissions. Yet another is to rate patient satisfaction. You can find these metrics on the Virginia Health Information website.

But health care is a phenomenally complex business, and many other aspects of hospital care are measurable. In a recent press release, the Virginia Hospital & Healthcare Association (VHHA) pointed out, for instance, that Virginia is one of 20 states (and Washington, D.C.) to earn an “A” for palliative care, based on a study by the Center to Advance Palliative Care and the National Palliative Care Research Center.

What is palliative care? It is, according to the report, “specialized medical care for people living with a serious illness. It is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness.”

Having witnessed the lingering deaths of a step mother and father-in-law in recent years, I get it. The goal should not be to prolong life at any cost but to improve the quality of life that remains. Continue reading

Dems & Dom, RGGI Grows, Medicaid & Work

By Steve Haner

What Was Lost Is Found Again.  Couldn’t they wait at least another few weeks?  Anybody foolish enough to believe that Dominion Energy Virginia and the Virginia Democratic Party establishment have really parted ways (as Jim Bacon seemed to think a while back), take note of this from today’s Richmond Times-Dispatch:   Governor Ralph Northam’s new communications director, Grant Neely, is totally plugged into the Dominion Energy/Richmond’s Navy Hill/Mark Warner and Bob Blue nexus.  You can fool some of the people some of the time, but certain Democrats just about any time you want.

Source: Philadelphia Inquirer

The P in PJM Now Joining RGGI.  Pennsylvania Governor Tom Wolf, a Democrat, has signed an executive order that his state should be the next to join the Regional Greenhouse Gas Initiative.  According to this from The Philadelphia Inquirer, the executive order route comes after being rebuffed by the legislature.  It is a strong first step but not a done deal, with litigation one possible route for opponents.  Virginia’s on-hold membership will likely be determined by the General Assembly elected next month.

Continue reading

Will These Insurance Ads Also Sway VA Voters?

“You Only Pay For What You Need”

By Steve Haner

As the state campaign debate rages about health insurance plan which are short term or less comprehensive than the Affordable Care Act, two  on-going national ad campaigns may cross-pollinate the debate.  They are bolstering the Republican position nicely.

The first are the spots with people saying they are worried about the various Medicare for All proposals. They express concerns about a more expensive one-size-fits-all approach. Well, isn’t that exactly what Democrats like Senate candidate Debra Rodman and other others are demanding in Virginia? One size fits all? In several districts they are attacking Republicans who voted to allow lower cost alternatives that didn’t offer all ACA features.  Continue reading

Don’t Abandon Medicaid Work Requirement

Cover art from 2014 JLARC report on Virginia’s array of workforce training programs. Another state report notes almost 860,000 served in 2017.

By Steve Haner

To Republicans who supported the 2018 decision to expand Medicaid services to more Virginians – and encouraged yes votes from reluctant colleagues — the promise to couple those benefits with pathways toward gainful employment was a key reason. The compromise has worked in other states as well.  Continue reading

Medicaid Expansion Cost Still Off-Budget, Elusive

By Steve Haner

All the signs point to trouble. The next state budget, a two-year plan to be proposed in December, adopted by March and implemented in July, may be caught between stagnant revenue and soaring spending.  The spending charge will be led once again by Medicaid.

Just how much the decision to expand Medicaid will cost in the future remains elusive.

The state’s fiscal prospects were explained to the General Assembly’s money committees September 16 and 17 by Secretary of Finance Aubrey Layne.  The highlights are summarized in this article for the Thomas Jefferson Institute for Public Policy, using the image of a strand of worry beads.  The article is being distributed today.  Continue reading